How this began with symbolic illnesses

Brian Broom

How this began with symbolic illnesses

November 22, 2016

How did the whole person approach develop? All histories go endlessly backwards (and forwards). But a major marker of change occurred in 1988 when, after several years away from my internal medicine (clinical immunology) practice, I re-ignited it and amalgamated it with my newly developed psychotherapy training. In short, I put together a highly conventional biomedical discipline with the mind-oriented perspectives of psychotherapy. An odd marriage.

I began to see things which had been invisible to me in my previous immunology practice roles. The major shock was the appearance of ‘symbolic’ illness, where it seemed that the physical illness fitted the story so exactly that it looked as if the body was ‘telling’ the same story. There was the young woman with unexplained vaginal and rectal bleeding who had been vaginally and anally raped fifteen years before. The woman with five years of continuous crippling mouth ulcers who couldn’t talk to her daughter about why the latter had left the Catholic church, and who got better after she was encouraged to talk with her daughter. I have written of many such examples in my books and they involve both minor and major illnesses.

Symbolic illness was a shock because my medical training was about physical diseases being entirely physical. A symbolic illness had to be an absurdity. But the many symbolic conditions I saw with vivid stories were blatantly physical and the disturbances in the body were visible, detectable, or measurable. They could not easily be relegated to the ‘psychosomatic’ bin, which is what we tend to do when we cannot detect something physical or measurable.  I did not have a plausible medical explanation for what I was seeing.

I found that people with chronic physical illnesses tended to get better once we brought the medical condition together with the patients ‘story’. Just connecting the two, or giving permission to think that they might be connected, helped some people. Working much harder on the story aspects helped others.

In an effort to make sense of this, while continuing to work with patients in a ‘mindbody’ way,  I read widely in psychoneuroimmunology, philosophy, psychotherapy, history of medicine, theories of embodiment, consciousness literature, modern physics, the nature of experience, the nature of language and the role of symbols, cross-cultural concepts, psychosomatics, modern theories of emotional expression and development, the nature of person-hood, and critiques of modern medicine and evidence-based medicine. And more.

And what I saw (as did many others) was that in Western healthcare (and culture) we had divided the person into compartments. The mind and body were separate. In medicine we treated bodily disturbance as largely separate from the mind (except in those conditions where we could not detect much or anything in the body, and these were the psychosomatic conditions).

If we think about the development of an infant it seems obvious that physicality (body) and subjectivity (mind, and our capacity for organising our experience) emerge together from the beginning. They are co-emergent. They are not separated. This means our bodies and our life experiences are not separate but mingled, and together. We are one, unitive, a whole. It follows that patients with disorders need to be considered as wholes and that so-called physical diseases merit seroius consideration of the non-physical, the ‘story’, the events that occurred before and around the time the illness emerged or relapsed (and so on).

Treating physical disease as if separate from a person’s life as a whole is a fundamental error, and negative for patients, because it shuts the door on involving a consideration of all those other life experience things which, if addressed, may cure, improve or modify the course of a physical illness. It also means that we are more and more committed to purely technological solutions to our chronic illness problems. And we see the costliness of that.

It is true that many patients are intent on getting a technological answer, and some of that is about being educated by Western culture and healthcare that that IS the only way. Some of it is about people not wanting to address tender or hurting areas of their lives. There are many factors.

Don’t get me wrong. I do not think that all illness is symbolic but the symbolic illnesses were the catalyst for seeing patients as whole persons. I highly value technological approaches in many conditions. But we need a combined approach, a whole person approach, which allows for diagnosis, drug and technological treatments and consideration of stories. Depending on each patient the treatment may be skewed one way or the other.

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Dr Brian Broom is a Consultant Physician (Clinical Immunology) and Psychotherapist in the Department of Immunology in Auckland City Hospital; and Adjunct Professor, Department of Psychotherapy, Auckland University of Technology.

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